Considerations for Left Atrial Appendage Closure in Older Adults

Atrial fibrillation and atrial flutter pose a significant morbidity and mortality burden with high global prevalence, particularly in older adults. One of the cornerstones of the care of patients with atrial fibrillation and flutter is cardioembolic stroke risk reduction which is primarily accomplished with oral anticoagulants. There, however, are patients who are unable to tolerate oral anticoagulation due to previous intolerance or anticipated risk of significant bleeding. Percutaneous left atrial occlusion devices have been developed and are an evidence-based strategy in reducing stroke risk without the long-term use of oral anticoagulants. Given the increased risk of both cardioembolic stroke as well as hemorrhagic events, this article reviews the important considerations for left atrial appendage occlusion in the older adult population.

A significant proportion of patients undergoing percutaneous left atrial appendage occlusion are older than 75 years of age. Several studies have discussed the procedural complication rate as well as the success rate for left atrial appendage occlusion in this patient population. While some studies may suggest that the procedural complication rate may be slightly higher, there is still significant evidence to support efficacy for stroke prevention in this age group.

Left atrial appendage occlusion is a frequently utilized alternative to oral anticoagulation in patients with atrial fibrillation who have long-term contraindications or intolerance to oral anticoagulants. Advancing age has not been demonstrated to significantly diminish the effectiveness of the procedure, but there may be slightly increased procedural-related adverse events associated in older adults and patients and providers should be counseled accordingly.